Stand-Alone Applications: Filling the LIS Functionality Gaps Liron Pantanowitz, MD

Transcription

1 Stand-Alone Applications: Filling the LIS Functionality Gaps Liron Pantanowitz, MD Associate Professor of Pathology & Biomedical Informatics University of Pittsburgh Medical Center

2 Conflict of Interest None

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4 Stand-Alone Apps Laboratory information system (LIS) at the core of most lab operations Legacy LIS as newer technology becomes available to perform tasks Add-on modules (SLAMs) & upgrades can extend/enhance a legacy LIS Supplemental solutions fill growing functionality gaps Enable labs to perform tasks not currently possible with existing hardware/software Tools often easy to use, maintain and many are plug-&-play (seamlessly connect to LIS) Provide increased efficiency, better patient care & ROI (e.g. save FTE time) Solutions may include: IT tools from middleware or lab instrument vendors Vendors cater to all size/type of labs (e.g. POLs) Expert services & training provided by consulting firms New user friendly & helpful solutions are constantly being designed

5 Demand Drivers Stand-alone applications provide inexpensive solutions for labs struggling with several problems: Staff shortages (med techs) Increased test volumes More complex instruments More complex lab operations EMRs demanding connectivity Trend toward ensuring quality of care

6 IMPROVEMENTS Operations (Management) Workflow (Processes) Productivity (Services) Quality (Safety & Compliance) Revenues (Billing)

7 Operation Improvements 3 rd -party software components that support LIS operations separate install recommended by LIS vendors (e.g. MS Word, AccuSoft, Excel, Crystal Reports) Data transmission (e.g. Forward Advantage manages faxes, LabDE automates capture & transfer of data in lab reports) Storage solutions (e.g. HP StorageWorks EVA8000, Mesa Corp) Support for virtual applications, legacy apps & web-based cloud management (e.g. VMWare, Citrix) User connectivity (e.g. remote login, password control) Electronic change control process (e.g. SharePoint) Automated testing software helps lab test new/changes to software (e.g. Software Testing Solution) Management of personnel & trainees (e.g. human resources packages, resident evaluation systems)

8 Workflow Improvements Need: Inefficient current processes Answer: Optimize workflow process Several solutions: Instrument connectivity & maintenance Automation (e.g. autoverification) Continuous (vs. batch) workflow (e.g. Lean tools) Tracking solutions (barcodes, RFID) Remote system monitoring (real-time, web-based) Scheduling (according to staff availability/subspecialty, work distribution & workload demands) Inventory management (supplies, reagents, equipment)

9 Middleware Plumbing - Stuck in the Middle Hardware & software that acts as an intermediary between instruments & LIS (connect legacy to newer systems) Allows data exchange or performs data management tasks the LIS can t handle 3 types of middleware solutions: Instrument level: Instrument data management Work area level: Work area management (WAM) Lab level: Lab production management e.g. Instrument Manager, Laboratory Production Manager, Remisol Advance, Sysmex WAM, TD- Harmony, Roche Middlware Solutions, JavLin interfaces, JResultNet, IM 2, AgilityEngine

10 WAM LIS Inventory LIS-Middleware Relationship

11 Autoverification Automatic review & release (verification) of results received from a lab instrument without technologist review Application of rule-based logic allows communication between a lab instrument & LIS to generate an action (pass/fail) based upon pre-defined rules/algorithms Greatest benefit obtained with frequently ordered tests (e.g., automated chemistry assays, routine hematology tests) Systems enabled through the lab instrument, middleware, or LIS

12 Apps for Automation Pre-Analytical Phase Courier services to optimize fleets, routes, special situations like stat specimens, tracking & call center coordination (e.g. Gajema, Logitrac, Elite) Pneumatic tubing systems (incl. carrier tracking) Specimen collection (e.g. scheduling) Analytical Phase Lab automation systems (robotic sub-systems, process control software) Sample processing, transportation & queuing Post-Analytical Phase Storage & retrieval systems (e.g. add-on testing)

13 Schematic IT hierarchical infrastructure of a laboratory automation system (LAS)

14 Advantages of Automation Increased productivity Offset staff shortages Economic gains Error reduction Improved turnaround time Avoid operator exposure to hazards (e.g. blood) Avoid operator exposure to injury (e.g. repetitive tasks)

15 Continuous Processes Improvement Lean & Six Sigma IT tool kits e.g. LeanKit Kanban Value stream mapping (draw, analyze & design workflows) Dashboards (real-time monitors of performance/metrics) LEAN SIX SIGMA

16 Asset Management Tracking solution benefits: Automate, standardize & timestamp data collection process Facilitate Lean manufacturing process (e.g. JIT technique & reduce turnaround time) Drive workflow at point of contact (e.g. barcode driven protocols) Error reduction (improve quality/patient safety) Provide measurable metrics to enhance processes (detect workflow bottlenecks) e.g. Vantage (Ventana)

17 Quality Improvements Need: Standardize QC/QA processes & continuously monitor compliance Answer: Single electronic database & current documentation Several solutions: Positive patient ID solutions (e.g. wcarecollect, BD.id, Identi-Match, MedPoint, CareChek) Statistics & method validation tools (e.g. GraphPad Prism, EP evaluator, Altosoft) Lab staff competency (web-based systems) Reporting & tracking of HR issues

18 QA Data Tools Notable LIS weakness: (collect, manipulate & display data) Utilize QA data outside LIS Automatic continuous updates ( real time ) User friendly (easy wizard approach) Better data management (impressive analytical capabilities & metrics) Superior displays (graphs, dashboards) Web-based solutions available Access varied database formats (Excel, SQL, Oracle)

19 Document Management Paperless environment Scan documents, requisitions & reference lab reports Easy document access, retrieval & data extraction Standardize electronic policy & procedure creation, review & approval e.g. SoftTech, policytech, Mesa, Zequel, Policy IQ, Vignette, PolicyMedical, OnBase, Extract Systems, Scantron

20 Service Improvements Need: Client & patient services Answer: Enhanced productivity, client satisfaction & better access to information Several solutions: Patient services (access to information & convenience) Client services (easy connectivity & tracking) Practice management systems

21 Patient Service Tools Access to lab results Online patient portals Maintain HIPAA compliance (e.g. eclinicalworks, CureMD, e-telmed) Scheduling Automated appointment management (e.g. Q-nomy, Quest)

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23 Client Service Tools Outreach LIS-EMR connectivity Several EHR integration solutions e.g. Lifepoint, Atlas, Initiate exchange platform, 4Medica, Halfpenny, CareEvolve, Blue Iris elaborate, JResultNet Lab portals Lab orders, test results, schedule pick-up, inquiries, specimen tracking, & determine status Electronic lab manuals (catalogs with test menu & user guide) Physician Office-Lab Links (POLL) Bidirectional connectivity between instruments & EMR e.g. Fflex elink, Atlas LabWorks, epathlink Help desk software Customer management & support (e.g. sample collection supplies, coordinate issues, follow up outstanding issues) Automatic call triage & recording e.g. TrackIT, CRMdesk, Request tracker, H2Desk

24 Data managed & routed using vendor server & software LIS-EMR Connectivity using SaaS Pantanowitz et al. J Pathol Inform 2010; 26:1

25 EMR Integration Issues LIS-EMR interface projects can be lengthy, unpredictable & costly to implement and maintain Solutions utilize innovative SaaS-based hub technology Bidirectional flow of data (orders match test results) Support CPOE from many EMRs Handle complexities (e.g. add-ons, cancels, reflex tests) Result delivery with appropriate downstream display Support mobile devices (on-the-go orders/ready-to-view results) Meet requirements for Meaningful Use certification Behind-the-scenes business rules tailored to match unique workflows, flexible test menus, coding & billing

26 Specific CP Apps Microbiology Infection & antibiogram surveillance Transfusion Medicine Transfusion safety (e.g. Final Check LIS codes) Virtual blood banking & remote refrigeration management Blood donor systems with computerassisted scheduling & interviewing

27 Specific AP Apps Dictation & transcription management (e.g. Winscribe, Voicebrook, Nuance) Synoptic reporting (e.g. mtuitive) FS diagnosis communication (e.g. Yale) Automated e-reporting to cancer registries (e.g. e-path) Tissue banking e.g. BIGR from Healthcare IT, Daedalus Autopsy (e.g. UPMC remains tracker)

28 Digital Pathology Solutions Image acquisition (e.g. gross & microscope capture workstations) Image management (e.g. Aperio Spectrum, Apollo PathPACS) Image workflow (e.g. Omnyx workstation) Telepathology (e.g. Zeiss robotic microscopy, CellaVision, web-based portals) Automation (e.g. Pap test screening) Image analysis (e.g. Ventana VIAS, CellSens, HistoRx, Farsight, Genie, TissueStudio, Inform)

29 Point-of-Care Testing Interface managers Interface with multiple vendor devices (open connectivity) Provide a single result feed to LIS (simplified compliance) Compliant with connectivity standards Support wireless connectivity e.g. Telcor Database management systems Flexible, web-based, centralized control Added features (e.g. QA, HR links to update staff updates, competency tools) e.g. Abbott PrecisionWeb

30 Electronic data flow from point of care to EMR

31 Revenue Improvements Need: Maximize profits Answer: Good business solutions Several solutions: Revenue cycle management tools - automate large volumes of transactions Features: LIS interface capability, server or browser based, management & marketing reports, compliance (e.g. HIPAA & coding such as LOINC) Outsourcing with consultants e.g. Boston WorkStation, Costflex, Peachtree, Lab Outreach Business Pro, PSA Billing & Collection Services, Chi Solutions

32 Practical Take Home Points Labs have limited resources (IT skills, finances, time) Middleware installation often easier than LIS upgrade One-size-does-not-fit all (customization) Beware of rapidly retired vogue solutions Flexible homegrown systems require IT skills Closed system architecture - middleware specific to vendor instruments may constrain the level of automation that can be achieved (e.g. inability to swap or add devices) Open system architecture middleware can interface with several vendor instruments & information systems Plan ahead & avoid middleware band-aid solutions that create more work (e.g. additional training, maintenance & troubleshooting)

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